Provider Demographics
NPI:1063813020
Name:GADULOV, YULIYA (MD)
Entity type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:GADULOV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YULIYA
Other - Middle Name:ILIEVA
Other - Last Name:DIMOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6837 YELLOWSTONE BLVD # 51
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3456
Mailing Address - Country:US
Mailing Address - Phone:516-342-0129
Mailing Address - Fax:
Practice Address - Street 1:6837 YELLOWSTONE BLVD # 51
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3456
Practice Address - Country:US
Practice Address - Phone:516-342-0129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP93534207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology